Mohammad Zobair Hasan -- Health and Health Care is one of the fundamental rights of the citizens of a country. Now private sectors are developing rapidly with government sector to ensure good health service. But unfortunately people are not getting proper services from public facilities due to lack of sufficient resources, utilization of those resources, unavailability of medicines, improper budget allocation and people's ignorance on health information are major aspects. The poor would be more benefited if the existing government health service institutions would function well. Government should take care closely the functionality of the present public health services to assure the health right of the poor, especially that of the vulnerable women and children. Administration of health financing is currently based on existing administrative units and health facilities (such as number of beds) but not based on needs. This resource allocation needs to be based on needs in health care units (wards, unions, upazila, districts level health facilities and medical college) particularly by re-allocation of existing resources as well as increasing resources, reducing wastage and improving efficient management practice. .Here "Local Government" along with the "Upazila Health and Family Planning Budget Club" must be entitled with enough authority to control, supervise and monitor the whole health service providing procedure to ensure better services, accountability, transparency and the proper use of the public funds and local resources. Government should adapt adequate monitoring system of public Health and family planning ensuring the participation of all stakeholders. In this regard there is a remarkable initiative taken by Development Organisation of the Rural Poor-DORP for Health Budget Monitoring. Accordingly, in April 2009, 6 pre-budget discussion sessions were held in 6 sub-districts to discuss local needs in line with people's expectations from the up-coming budget 2009-10.
Total 266 people including health and family planning staffs from upazila and unions, teachers, union council members, journalists, small and medium entrepreneurs (businessman), Imam ( religious leader), mid-wives, college students, lawyers, Union council chairmen, local elites, social workers, community people were participated in the pre-budget discussions at 6 Upazilas. Besides, Member of Parliament, Upazila Chairman, Upazila Vice-chairman (female), Local leaders grace the occasion as chief guest, special guest which encouraged local people. Following recommendations have been arisen from 6 Upazila from 6 Divisions of the country.
Bakergonj (Barisal) Recommendations:
In 12 unions, all union health centers do not have sufficient medicine, cleanliness budget including proper utility services i.e electricity, water, gas. Need to increase sufficient allocation in "supply and services" of Revenue budget.
Budget for Essential Service Delivery (ESD), need to be increased, particularly for reproductive health care and child health care.
Those who provide services and responsible to manage union health centers, should be open to discuss with Union Council standing committee.
More "Citizen Charter" should introduce at outside of the health complex and health centers.
Massive information dissemination (through postering, miking, courtyard meeting etc) is needed to inform the available health services to the poor. Need increase of Awareness.
Strong and effective monitoring by involving union council members for conducting "Satellite Clinic" and "EPI Sessions" would fulfill peoples needs at very door steps.
Budget for each Community Clinic is needed to ensure to activate those.
Kamal Nagar (Laxmipur) Recommendations:
42 Vacant posts for health department need to be filled-up as soon as possible to get better health services.
Supply of medicine should be increased and continued without interruption.
All 46 Community Clinic must be activated and functioned.
Full-filling the Vacant post of char "Kalkini Union of Family Welfare Centres" will increase the health services of the local poor.
Vacant post of Nurse needs to be full-filled for Upazila health Complex.
Some of the Unions, do not have health centres. Infrastructure should be established or should initiate to establish in that Unions.
Ambulance is out of order. One new Ambulance is demanded with fuel and maintenance cost.
Total 38 respondents participated and out of which 15 emphasized on the increase of publicity and advertisement.
Sirajgonj Sadar ( Sirajgonj) Recommendations
Need increase to allocation on 5 components of Essential Services Delivery (ESD) at Sirajgong Sadar and its surrounding Union Health and Family Welfare Centers (UHFWC).
Insufficient and scrap medical equipment make delay in service or insist to refer to the private clinic. Budget for equipment's "operation and maintenance" need to increase.
Budge allocation for community clinic is essential to provide services at ward and village level.
In 2 Unions (Kaowakhali and Mesra), temporary health service camp ( there is no health centers) has arranged after intervention of local Budget Club; making available of sufficient medicines and continuous visiting of responsible SACMO and MO-MCH for those Unions is needed.
Massive information should make available at very village level to ensure utilization of "Publicity and advertisement" budget.
Budget is available for Human Resources, but due to vacancy of health and family planning workforce, budget is not utilized and people are deprived from services. Need to accelerate to fulfilling vacant posts.
Medicine budget or medicine quantity needs to be increased.
Lohagara (Narail) Upazila Recommendations:
Increase allocation to purchase/ supply Medical and Surgical Requisite (MSR), as the existing MSR is very old.
An Ambulance with annual sufficient allocation for Petrol/Octane is badly needed for Lohagora Upazila Health Complex.
Upazila Health Complex Advisory Committee should organize the pre-budget session(s) at least once in a year. So that, local needs can be reflected to the health and family planning budget each year through involving health complex authority.
Service related information at outside the health complex will increase the accessibility of poor. Many people do not know what services are available at what time from the health complexes and health centers.
Affirmative steps to continue the monitoring and awareness program by involving local community like Union Health, Family Planning and Epidemic Standing Committee at Union levels and Budget Club (Civil Society Group) at Upazila level.
Create open discussions on allocated budget and utilization with Locals to reduce gaps of understanding
Kamalgonj (Moulovibazar) Upazila Recommendations:
Budget allocation in line with population to address health for all.
Ensure recurrent budget for better utilization of existing equipments i.e x-ray, nebulizer, and pathological equipments.
Ensure the supply of MSR in time.
Once in a year, health complex authority can organize "opinion discussion" with the locals
Utilization of MLSS to make the hospitals and centers clean, and make them positive to provide service. Many support staffs are absent or posts are vacant (e.g Technicians, Radiographer) for long time but service users of this Upazila do not know the real picture of health workforce supposed to be available from government.
Collective actions under the leadership of Upazila Chairman should welcome from the Upazila Health and Family Planning officer (THFPO) to make the peoples' participation sustainable.
Kaliakoir (Gazipur) Upazila Recommendations:
Budget allocation in line with population need based
Allocation need to increase in line item "fuel/gas)" under the budget head of "supply and services" of Revenue budget.
Community should get enough access to health and family planning related information from the health centres and also at door steps.
Allocation of inception budget for Community Clinic is needed to operate the clinic. The community clinics are closed since 2001, and it is decided by the present government to re-open.
"Chapair" union does not have Union Health and Family Welfare centers while all other unions have strong demand is created to establish the UHFWC at "Chapair" Union .
Concluding Remarks:
Bangladesh government is the sole responsible authority to provide health and health care services to all citizens in the country and Ministry of Health and Family Welfare is the focal ministry to address this responsibility. Government of Bangladesh is a resource constrained authority and therefore needs its citizen's participation and contribution in the process of management through various forms.
Government as well as Ministries have made commitments, as recorded in different conventions, protocols, and agreements, to allocate and transfer adequate financial resources at Upazila level for health and family planning services where most of the rural and poor people live.
But actual transfer has so far been meager since long time and it is not meeting the present minimum needs. Urgency and needs is being conveyed through various methods, and pre-budget discussions is one of them, while it may reduce some gap between supply and demand on Upazila health and family planning service provisions for the poor.
Source: nation.ittefaq.com
